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@ARTICLE{Sprave:154502,
      author       = {T. Sprave$^*$ and A. Rühle$^*$ and K. Hees and T.
                      Kalckreuth$^*$ and V. Verma and R. Stoian and C.
                      Zamboglou$^*$ and J. Pfeiffer and R. Laszig and A. Knopf and
                      A.-L. Grosu$^*$ and N. Nicolay$^*$},
      title        = {{R}adiotherapeutic management of cervical lymph node
                      metastases from an unknown primary site - experiences from a
                      large cohort treated with modern radiation techniques.},
      journal      = {Radiation oncology},
      volume       = {15},
      number       = {1},
      issn         = {1748-717X},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {DKFZ-2020-00824},
      pages        = {80},
      year         = {2020},
      abstract     = {To analyze management and outcomes following
                      (chemo)radiation therapy in patients with cervical lymph
                      node metastases from an unknown primary site (CCUP) in a
                      large single-center cohort.Between 2008 and 2019, 58
                      patients with CCUP were treated with (chemo)radiation
                      therapy at the University of Freiburg Medical Center and
                      were included in this analysis. Overall survival (OS),
                      locoregional progression-free survival (PFS) and distant
                      metastasis-free survival (DMFS) were calculated using the
                      Kaplan-Meier method. The use of diagnostic procedures and
                      their impact on oncological outcomes was analyzed by Cox
                      regression, and treatment-related toxicities were
                      quantified.Median follow-up was 29.9 months (range
                      4.6-121.9). Twenty-one patients $(36.2\%)$ received
                      definitive RT, 35 $(60.3\%)$ underwent adjuvant RT, and 2
                      $(3.4\%)$ were treated for oligometastatic disease.
                      Concurrent chemotherapy was prescribed in 40 patients
                      $(69.0\%).$ $89.6\%$ of patients completed the prescribed
                      RT, and $65.0\%$ completed the prescribed simultaneous
                      chemotherapy. Locoregional recurrence was observed in 7
                      patients $(12.1\%)$ and distant metastases in 13 cases
                      $(22.4\%).$ OS was 81,1, $64.9\%$ and $56,6\%$ after 1, 3
                      and 5 years, respectively. Univariate analysis of age,
                      gender, extracapsular spread, tumor grading, neck
                      dissection, diagnostic utilization of 18F-fluorodeoxyglucose
                      positron-emission tomography and concomitant chemotherapy
                      showed no effect on OS (p > 0.05 for all), while smoking
                      was significantly associated with decreased survival
                      (p < 0.05). There was a trend towards impaired OS for
                      patients with advanced nodal status (pN3) (p = 0.07).
                      Three patients $(5.2\%)$ experienced grade 3 radiation
                      dermatitis, and 12 $(22.4\%)$ developed grade 3 and 1
                      $(1.7\%)$ grade 4 mucositis.RT of the panpharynx and
                      cervical lymph nodes with concurrent chemotherapy in case of
                      risk factors demonstrated good locoregional control, but the
                      metachronous occurrence of distant metastases limited
                      survival and must be further addressed.},
      cin          = {FR01 / E055},
      ddc          = {610},
      cid          = {I:(DE-He78)FR01-20160331 / I:(DE-He78)E055-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:32293497},
      doi          = {10.1186/s13014-020-01529-z},
      url          = {https://inrepo02.dkfz.de/record/154502},
}